Detection of venous air embolism by continuous intraarterial oxygen monitoring.
In a recent study, we compared a new intraarterial fiberoptic "optode" probe to continuously measure arterial oxygen and carbon dioxide tensions and pH with intermittently drawn blood samples in patients undergoing surgery. In one patient with a diagnosis of Arnold-Chiari type I malformation with outflow obstruction of the fourth ventricle, a major pulmonary air embolism occurred while the patient was undergoing suboccipital craniectomy and cervical laminectomy in the prone position. Three hours after the incision the optode-displayed oxygen tension decreased from a stable value of 225 +/- 8 mm Hg to 63 mm Hg over a 10-minute period. During the same interval, carbon dioxide tension increased and end-tidal carbon dioxide decreased; shortly thereafter, transcutaneous oxygen tension decreased also. Within 20 minutes after the inspired gas mixture was changed to 100% oxygen, the patient's respiratory variables returned to near baseline. No further complications ensued. This is the first time continuously monitored arterial oxygen tension values during a pulmonary embolism have been reported. With further refinement, intraarterial optode probes will add another valuable method of detecting pulmonary air embolism.
Greenblott
G
G
Department of Anesthesiology, University of California, Irvine Medical Center, Orange 92668.
Barker
S J
SJ
Tremper
K K
KK
Gerschultz
S
S
Gehrich
J L
JL
D000328:Adult; D003399:Craniotomy; D005336:Fiber Optic Technology; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008991:Monitoring, Physiologic / Q000592:standards*; D010100:Oxygen / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology
D010100:Oxygen